TY - JOUR
T1 - Outcomes of persons with coronavirus disease 2019 in hospitals with and without standard treatment with (hydroxy)chloroquine
AU - Peters, Edgar J. G.
AU - Collard, Didier
AU - van Assen, Sander
AU - Beudel, Martijn
AU - Bomers, Marije K.
AU - Buijs, Jacqueline
AU - de Haan, Lianne R.
AU - de Ruijter, Wouter
AU - Douma, Renée A.
AU - Elbers, Paul W. G.
AU - Goorhuis, Abraham
AU - Gritters van den Oever, Niels C.
AU - Knarren, Lieve G. HH.
AU - Moeniralam, Hazra S.
AU - Mostard, Remy L. M.
AU - Quanjel, Marian J. R.
AU - Reidinga, Auke C.
AU - Renckens, Roos
AU - van den Bergh, Joop P. W.
AU - the CovidPredict Study Group
AU - Vlasveld, Imro N.
AU - Sikkens, Jonne J.
AU - CovidPredict Study Group
N1 - Funding Information: D. Collard is supported by a ZonMw grant (project no.: 10430022010002 ). Publisher Copyright: © 2020 The Author(s) Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/2
Y1 - 2021/2
N2 - Objective: To compare survival of individuals with coronavirus disease 2019 (COVID-19) treated in hospitals that either did or did not routinely treat patients with hydroxychloroquine or chloroquine. Methods: We analysed data of COVID-19 patients treated in nine hospitals in the Netherlands. Inclusion dates ranged from 27 February to 15 May 2020, when the Dutch national guidelines no longer supported the use of (hydroxy)chloroquine. Seven hospitals routinely treated patients with (hydroxy)chloroquine, two hospitals did not. Primary outcome was 21-day all-cause mortality. We performed a survival analysis using log-rank test and Cox regression with adjustment for age, sex and covariates based on premorbid health, disease severity and the use of steroids for adult respiratory distress syndrome, including dexamethasone. Results: Among 1949 individuals, 21-day mortality was 21.5% in 1596 patients treated in hospitals that routinely prescribed (hydroxy)chloroquine, and 15.0% in 353 patients treated in hospitals that did not. In the adjusted Cox regression models this difference disappeared, with an adjusted hazard ratio of 1.09 (95% CI 0.81–1.47). When stratified by treatment actually received in individual patients, the use of (hydroxy)chloroquine was associated with an increased 21-day mortality (HR 1.58; 95% CI 1.24–2.02) in the full model. Conclusions: After adjustment for confounders, mortality was not significantly different in hospitals that routinely treated patients with (hydroxy)chloroquine compared with hospitals that did not. We compared outcomes of hospital strategies rather than outcomes of individual patients to reduce the chance of indication bias. This study adds evidence against the use of (hydroxy)chloroquine in hospitalised patients with COVID-19.
AB - Objective: To compare survival of individuals with coronavirus disease 2019 (COVID-19) treated in hospitals that either did or did not routinely treat patients with hydroxychloroquine or chloroquine. Methods: We analysed data of COVID-19 patients treated in nine hospitals in the Netherlands. Inclusion dates ranged from 27 February to 15 May 2020, when the Dutch national guidelines no longer supported the use of (hydroxy)chloroquine. Seven hospitals routinely treated patients with (hydroxy)chloroquine, two hospitals did not. Primary outcome was 21-day all-cause mortality. We performed a survival analysis using log-rank test and Cox regression with adjustment for age, sex and covariates based on premorbid health, disease severity and the use of steroids for adult respiratory distress syndrome, including dexamethasone. Results: Among 1949 individuals, 21-day mortality was 21.5% in 1596 patients treated in hospitals that routinely prescribed (hydroxy)chloroquine, and 15.0% in 353 patients treated in hospitals that did not. In the adjusted Cox regression models this difference disappeared, with an adjusted hazard ratio of 1.09 (95% CI 0.81–1.47). When stratified by treatment actually received in individual patients, the use of (hydroxy)chloroquine was associated with an increased 21-day mortality (HR 1.58; 95% CI 1.24–2.02) in the full model. Conclusions: After adjustment for confounders, mortality was not significantly different in hospitals that routinely treated patients with (hydroxy)chloroquine compared with hospitals that did not. We compared outcomes of hospital strategies rather than outcomes of individual patients to reduce the chance of indication bias. This study adds evidence against the use of (hydroxy)chloroquine in hospitalised patients with COVID-19.
KW - Chloroquine
KW - Coronavirus disease 2019
KW - Hydroxychloroquine
KW - Mortality
KW - Severe acute respiratory syndrome coronavirus 2
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85096122599&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/33068758
UR - http://www.scopus.com/inward/record.url?scp=85096122599&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.cmi.2020.10.004
DO - https://doi.org/10.1016/j.cmi.2020.10.004
M3 - Article
C2 - 33068758
SN - 1198-743X
VL - 27
SP - 264
EP - 268
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
IS - 2
ER -